Physiotherapy

Editors

2010-06-01

A cognitive-behavioural programme for the management of low back pain in primary care: a description and justification of the intervention used in the Back Skills Training Trial (BeST; ISRCTN 54717854)

Z. Hansen, A. Daykin, S.E. Lamb — 2010-01-15

Abstract: A multicentre randomised controlled trial has been commissioned to evaluate cognitive-behavioural (CB) approaches in the management of subacute and chronic low back pain in primary care. This paper describes the development of the CB intervention based on best-available evidence. Several methods were used to design the intervention. Risk factors for the development of chronic low back pain were identified from the literature to provide targets for treatment, essential components of a CB intervention were considered using the CB treatment model, and the optimal delivery method was used to balance clinical effectiveness and cost-effectiveness within primary care.

The effectiveness of corticosteroid injections compared with physiotherapeutic interventions for adhesive capsulitis: A systematic review

Victoria Blanchard, Steven Barr, Frances L. Cerisola — 2009-11-16

Abstract: Objectives: To determine the effectiveness of corticosteroid injections compared with physiotherapeutic interventions for the treatment of adhesive capsulitis/frozen shoulder.Data sources: The electronic databases MEDLINE, EMBASE, CINAHL and AMED were searched up to Week 23 2009. Additional database searching included the Cochrane Central Register of Controlled Clinical Trials, the Physiotherapy Evidence Database (PEDro), the National Research Register and the National Recognition Information Centre, also up to Week 23 2009.Review methods: All English-language studies were eligible for inclusion if they showed evidence of random allocation of subjects to either a corticosteroid injection group or a physiotherapeutic intervention group. Studies were considered for inclusion if participants had a stated diagnosis of adhesive capsulitis/frozen shoulder or restriction of passive or active movement in two or more planes. The primary outcomes of interest were pain, external rotation and shoulder disability/function. Quality assessment was assessed using the PEDro scale. Standardised mean differences and effect estimates were calculated for the outcomes of pain, external rotation and shoulder disability at various follow-up periods.Results: Six studies were deemed eligible for inclusion in the final review. All had evidence of random allocation to either an injection group or a physiotherapeutic intervention group. There were some differences between the studies with regard to both the corticosteroid injections and physiotherapeutic interventions. Standardised mean differences and effect estimates were calculated for three of the included studies at various follow-up periods. There was a medium effect for corticosteroid injections compared with physiotherapeutic interventions for the outcomes of pain, passive external rotation and shoulder disability at 6 weeks. There was only a small effect in favour of corticosteroid injections for pain, passive external rotation and shoulder disability at 12 to 16 weeks and 26 weeks, and pain and shoulder disability at 52 weeks.Conclusion: The results of this review suggest that corticosteroid injections have greater effect in the short term compared with physiotherapeutic interventions. This decreased over time, with only a small effect in favour of injections in the longer term. The results of this review must be interpreted with some caution due to the limited number of studies and differences in the interventions between the studies.

The impact of home-based physiotherapy interventions on breathlessness during activities of daily living in severe COPD: A systematic review

Martin J. Thomas, Janet Simpson, Richard Riley, Emily Grant — 2010-01-18

Abstract: Objectives: To conduct a systematic review and meta-analysis to determine the impact of home-based physiotherapy interventions on breathlessness during activities of daily living (ADL) in severe chronic obstructive disease (COPD).Data sources: The electronic databases AMED, CINAHL, Cochrane Central Register of Controlled Trials, Embase, Medline and Physiotherapy Evidence Database (PEDro) were searched from their inception to Week 20 2008. Bibliographies of all potentially relevant retrieved studies, identified relevant systematic reviews and international guidelines were searched by hand.Review methods: Inclusion criteria consisted of individuals over 18 years of age with severe COPD (defined as forced expiratory volume in 1 second ≤50% predicted) without cardiovascular co-morbidities, home-based interventions and valid, reliable breathlessness ADL outcome measures. The PEDro scale assessed methodological quality. Data extraction included baseline characteristics, treatment intervention, frequency of training, level of supervision, breathlessness ADL outcome measure and results. Where possible, a random-effects meta-analysis was applied to appropriate trial data to produce overall quantitative results.Results: Seven studies, providing nine data sets, met the inclusion criteria. Trial PEDro scores ranged from 4 to 7 out of 10. Studies were homogenous at baseline regarding age and COPD severity, although subjects were predominantly male. Five studies investigated inspiratory or expiratory muscle training, and two studies investigated exercises. Statistically significant breathlessness ADL outcome improvements were reported for all interventions except expiratory muscle training. Five studies demonstrated clinical significance (four for inspiratory muscle training and one for exercise). However, due to heterogeneity among study interventions and outcomes, meta-analysis was only considered clinically appropriate on one occasion to pool three inspiratory muscle training studies in relation to breathlessness score. The random-effects meta-analysis indicated that, on average, inspiratory muscle training improved the breathlessness score significantly by 2.36 (95% confidence interval 0.76 to 3.96) compared with controls.Conclusion: Inspiratory muscle training and exercise are home-based physiotherapy interventions that may improve breathlessness during ADL in severe COPD. Administration can only be advocated tentatively in outpatient services and primary care at this stage because further higher quality, more homogeneous research with larger sample sizes is required to substantiate the current findings.

Cervical spine mobilisation forces applied by physiotherapy students

Suzanne J. Snodgrass, Darren A. Rivett, Val J. Robertson, Elizabeth Stojanovski — 2009-12-23

Abstract: Objectives: Postero-anterior (PA) mobilisation is commonly used in cervical spine treatment and included in physiotherapy curricula. The manual forces that students apply while learning cervical mobilisation are not known. Quantifying these forces informs the development of strategies for learning to apply cervical mobilisation effectively and safely. This study describes the mechanical properties of cervical PA mobilisation techniques applied by students, and investigates factors associated with force application.Participants: Physiotherapy students (n=120) mobilised one of 32 asymptomatic subjects.Methods: Students applied Grades I to IV central and unilateral PA mobilisation to C2 and C7 of one asymptomatic subject. Manual forces were measured in three directions using an instrumented treatment table. Spinal stiffness of mobilised subjects was measured at C2 and C7 using a device that applied a standard oscillating force while measuring this force and its concurrent displacement. Analysis of variance was used to determine differences between techniques and grades, intraclass correlation coefficients (ICC) were used to calculate the inter- and intrastudent repeatability of forces, and linear regression was used to determine the associations between applied forces and characteristics of students and mobilised subjects.Results: Mobilisation forces increased from Grades I to IV (highest mean peak force, Grade IV C7 central PA technique: 63.7N). Interstudent reliability was poor [ICC(2,1)=0.23, 95% confidence interval (CI) 0.14 to 0.43], but intrastudent repeatability of forces was somewhat better (0.83, 95% CI 0.81 to 0.86). Higher applied force was associated with greater C7 stiffness, increased frequency of thumb pain, male gender of the student or mobilised subject, and a student being earlier in their learning process. Lower forces were associated with greater C2 stiffness.Conclusion: This study describes the cervical mobilisation forces applied by students, and the characteristics of the student and mobilised subject associated with these forces. These results form a basis for the development of strategies to provide objective feedback to students learning to apply cervical mobilisation.

Effect of the abdominal draw-in manoeuvre in combination with ankle dorsiflexion in strengthening the transverse abdominal muscle in healthy young adults: A preliminary, randomised, controlled study

Seung-Chul Chon, Ki-Yeon Chang, Joshua (Sung) H. You — 2009-11-13

Abstract: Objectives: To compare the effect of the abdominal draw-in manoeuvre with the abdominal draw-in manoeuvre in combination with ankle dorsiflexion on changes in muscle thickness and associated muscle activity in abdominal muscles.Design: A preliminary, randomised, controlled study.Setting: University laboratory.Participants: Forty healthy adults (18 males, 22 females) were allocated at random to the experimental group [mean age (SD) 24 (1.6) years, n=20] or the control group [mean age (SD) 24 (1.9) years, n=20]. The experimental group performed the abdominal draw-in manoeuvre in combination with ankle dorsiflexion, and the control group performed the abdominal draw-in manoeuvre alone, five times a day.Main outcome measures: Ultrasonography and electromyography were used to determine the intervention-related changes in muscle activity and the thickness of abdominal muscles during the abdominal draw-in manoeuvre or the abdominal draw-in manoeuvre in combination with ankle dorsiflexion.Results: A significant difference was found in the thickness of the transverse abdominal muscle between the groups [mean difference 0.24cm, 95% confidence interval (CI) 0.08 to 0.40, P=0.005. On electromyography, a significant difference was demonstrated in the amplitude of the transverse abdominal muscle contraction between the two techniques in the experimental group (mean difference 68.76mV, 95% CI 53.16 to 84.36, P=0.000. The intra-class correlation coefficient (ICC2,1) showed excellent test–retest reliability of ultrasound measurement of the abdominal muscles: 0.96 (95% CI 0.85 to 0.99) for the transverse abdominal muscle, 0.87 (95% CI 0.62 to 0.98) for the internal oblique muscle and 0.77 (95% CI 0.44 to 0.96) for the external oblique muscle.Conclusions: This is the first study to demonstrate the additive effect of ankle dorsiflexion on deep core muscle thickness and activity, thus contributing to existing knowledge about therapeutic exercise for the effective management of low back pain.

The effect of a group education programme on pain and function through knowledge acquisition and home-based exercise among patients with knee osteoarthritis: A parallel randomised single-blind clinical trial

Tomer Bezalel, Eli Carmeli, Michal Katz-Leurer — 2010-01-22

Abstract: Objectives: To assess the effect of a group education programme on pain and function through knowledge acquisition and a home-based exercise programme.Design: A parallel randomised single-blind clinical trial.Participants: Fifty patients aged 65 years or over with knee osteoarthritis.Interventions: The study group (n=25) was given a group education programme once a week for 4 weeks, followed by a self-executed home-based exercise programme. The controls (n=25) were given a brief course in short-wave diathermy treatment.Main outcome measures: Patients were assessed before the intervention, after the intervention (4 weeks) and again 8 weeks later (follow-up) using the Western Ontario McMaster Osteoarthritis Index (WOMAC), the repeated sit-to-stand test and the get-up-and-go test.Results: At 4 weeks, there was a significant improvement in both groups in all outcome variables except the WOMAC stiffness score; for example, the WOMAC total score was reduced by a mean of 9.5 points [95% confidence interval (CI) −12.3 to −6.7]. However, at follow-up, patients in the study group demonstrated continued improvement in the get-up-and-go test and the WOMAC total, pain and disability scores, but no such improvement was noted among the controls. This difference was significant; for example, the difference in mean WOMAC total score between the groups was −9.0 points (95%CI −14.5 to −3.4).Conclusion: A simple group education programme for patients with knee osteoarthritis is associated with improved functional abilities and pain reduction. Further study is required to determine if this positive effect can be maintained over a longer period.

The effect of a physiotherapy education compared with a non-healthcare education on the attitudes and beliefs of students towards functioning in individuals with back pain: An observational, cross-sectional study

Cormac Ryan, Dervla Murphy, Michael Clark, Andrew Lee — 2010-01-20

Abstract: Objectives: To investigate the difference in attitudes: (1) between first and fourth year physiotherapy students towards functioning in individuals with back pain; and (2) between physiotherapy students and non-healthcare students towards functioning in individuals with back pain.Design: Observational, cross-sectional study.Setting: Glasgow Caledonian University, Scotland, UK.Participants: First year physiotherapy (n=61) and non-healthcare students (n=61), and fourth year physiotherapy (n=62) and non-healthcare students (n=62).Main outcomes: All participants completed the Health Care Providers’ Pain and Impairment Relationship Scale (range 15 to 105). This questionnaire measures attitudes towards functioning in individuals with back pain.Results: Fourth year physiotherapy students had more positive attitudes towards functioning in individuals with back pain than first year physiotherapy students [57.4 vs 66.6 (mean difference −9.2, 95% confidence interval −12.2 to −6.1, P<0.01)]. Similarly, fourth year non-healthcare students had more positive attitudes towards functioning in individuals with back pain compared with first year non-healthcare students [69.2 vs 65.3 (mean difference −3.9, 95% confidence interval −7.2 to −0.5, P=0.03)]. Physiotherapy students had more positive attitudes than non-healthcare students in the first year [66.6 vs 69.2 (mean difference −2.6, 95% confidence interval −5.5 to 0.4, P=0.08)] and the fourth year [57.4 vs 65.3 (mean difference −7.9, 95% confidence interval −11.4 to −4.4, P<0.01)] of study.Conclusion: These findings suggest that physiotherapy education brings about positive student attitudes towards functioning in individuals with back pain. This may be partly attributable to receiving a university degree education, but would appear to be further enhanced by specifically receiving a physiotherapy degree. This may facilitate students to become more evidence-based practitioners following qualification.

Cognitive determinants of pain and disability in patients with chronic whiplash-associated disorder: A cross-sectional observational study

Dave P. Thompson, Jacqueline A. Oldham, Martin Urmston, Steve R. Woby — 2010-01-22

Abstract: Objective: To delineate the relative extent to which specific cognitive factors are related to levels of pain and disability in patients with chronic whiplash-associated disorder.Design: Cross-sectional observation study.Setting: Three secondary care physiotherapy departments in the Greater Manchester region of the UK.Participants: All patients with chronic whiplash-associated disorder referred to the participating departments were invited to take part in the study. In total, 124 patients were invited to participate, and 63 (51%) agreed to do so. Complete data were available for 55 (44%) of those invited to participate in the study.Main outcome measures: Pain and disability, as assessed by the Neck Disability Index.Results: Cognitive factors were strongly related to levels of disability (R2 change=0.39, P<0.001). Specifically, greater catastrophising (β=0.41, P<0.01) and lower functional self-efficacy beliefs (β=−0.47, P<0.001) were significantly related to greater levels of disability. Significant univariate correlations were seen between the cognitive factors and current pain intensity. However, no significant associations were seen between the cognitive factors and current pain intensity in the multivariate analysis.Conclusions: Interventions which aim to reduce catastrophising and enhance functional self-efficacy beliefs should be included alongside conventional physiotherapy interventions when treating patients with chronic whiplash-associated disorder.

Lost in translation? How patients perceive the extended scope of physiotherapy in the emergency department

Sophie Anaf, Lorraine A. Sheppard — 2010-01-11

Abstract: Objectives: To investigate the perceptions of emergency department physiotherapy practice by emergency patients in metropolitan and regional Australia with a view to probing how consumers interpret the place of physiotherapy in such an acute, non-traditional setting.Design: A qualitative investigation using a descriptive open-ended questionnaire technique was administered to emergency patients in order to thematically analyse their perceptions of emergency physiotherapy practice.Setting: Case 1 was a metropolitan emergency department in Melbourne, Australia. Case 2 was a regional emergency department in North Queensland, Australia.Participants: A purposeful, convenience sample of 80 emergency department patients (n=40, Case 1; n=40, Case 2) responded to the open-ended questionnaire.Analysis: Data were thematically analysed using NVivo software and manual analysis, facilitating constant case comparison, and were reflected upon continually within an interpretivist framework.Results: Participants at both emergency departments had a general, but limited, awareness of the role of physiotherapy. Among multiple themes identified were six key domains which participants could recognise as being both the role of general physiotherapy and also relevant to the emergency setting. These were sports injury management, musculoskeletal care, rehabilitation and mobility, pain management, respiratory care and management of elderly patients. Discussions also involved those areas that were specific to general physiotherapy practice or emergency department care but which did not overlap.Conclusions: Participants in this study demonstrated a general, but limited, awareness of the scope of physiotherapy practice. There was strong identification of musculoskeletal-based interventions, with less familiarity with the potential role of physiotherapy in cardiorespiratory and rehabilitative management. Further research is needed on consumer awareness of the broader, less traditional roles of physiotherapy to increase acceptance and familiarity of its extended scope.

Are physiotherapy students adequately prepared to successfully gain employment?

Mandy Jones, Judith McIntyre, Sandra Naylor — 2010-01-27

Abstract: Objectives: To explore the preparedness of final-year physiotherapy students for their progression into employment, and identify what universities can do to facilitate a smooth transition.Design: A single-cohort study, utilising a qualitative design incorporating a survey followed by transcribed and coded semi-structured interviews.Setting: Interviews were held in the Placement and Careers Centre at Brunel University, London.Participants: Sixty final-year full- and part-time students participated in the survey, and 12 final-year full- and part-time students participated in the semi-structured interviews.Methods: Sixty students completed a questionnaire which explored their preparedness for employment. Questions related to the current job situation, the application process and the student's ideal first post. Responses from the questionnaire were analysed and discussed further through a digitally recorded interview. Twelve students were interviewed by an experienced interviewer from a non-physiotherapy background.Results: Students felt unprepared for employment. Forty-seven per cent wanted a rotational post, but 26% would only spend 6 months and 39% would only spend 1 year looking for a job. Seventy-one percent would change career and 99% would work abroad if they were unable to secure a post in the UK. Most importantly, students could not identify transferable skills required by potential employers; only 25% cited effective communications, and 10% cited flexible working as a transferable skill. Self-management skills (e.g. prioritisation, time management and documentation) were not perceived as essential for employment.Conclusions: The job market requires physiotherapy graduates to possess transferable skills which can be applied to any situation. Many are integral to the profession and the undergraduate curriculum; however, analysis and assimilation of these skills cannot be assumed. Universities should reflect on their curriculum delivery to produce graduates who meet employers’ expectations and make a smooth transition into the workplace.

Lindsay M. Bearne — 2009-02-24

This book aims to create a comprehensive, single-volume atlas of anatomy using detailed illustrations, diagrams and radiographs. It is arranged in a regional format (i.e. back, thorax, abdomen and pelvis etc.) based on current dissecting approaches. Each region is represented with very detailed, beautifully produced illustrations, supplemented with schematic diagrams in key areas and simplified summary tables. Each component is examined systemically, followed by topographical images to tie in the systems within regions together.

Dean Phillips — 2009-02-23

This is a well-written, easy-to-follow book with a clear layout. It provides an update on current research understanding of acute and chronic whiplash-associated disorders, cervicogenic headache and neck pain, including cervicobrachial pain. The authors provide a useful critique and analysis of a large body of relevant research, and background literature. The implications for current practice and directions for future clinical research are discussed.

Paulette van Vliet — 2009-03-16

The third edition of this valuable guideline aims to improve the quality of care delivered to people who have had strokes in the UK by providing ‘comprehensive and coherent guidelines on stroke care’ to clinical staff, those who purchase stroke services, managers, patients and their carers. For the most part, this aim is achieved. The book is organised into detailed sections devoted to different aspects of stroke care, including stroke management systems, rehabilitation and acute stroke care. It also contains a handy, concise, look-up guide for physiotherapists. The first section should be read (pp. 1–13) to allow the reader to understand the derivation of the guidelines and the approach to deciding on recommendations.

Martin Thomas — 2009-09-01

This book provides a practical and comprehensive set of clinical tests covering all major regions of the musculoskeletal system. Each chapter proceeds with a clear algorithm depicting symptoms, tests and diagnosis, accompanied with range-of-motion illustrations and an overview of each joint. A step-by-step procedure for each clinical test is provided, together with brief discussion of the assessment evaluation and likely diagnosis.

John Buckley — 2009-11-13

The principal aim of this book is to provide a handy pocket guide to exercise, that physiotherapists can carry with them as a reference source during clinical practice. The title of the book includes the logical progression of events of assessment, prescription and training. The book does cover these areas, but does not present the processes in a logical order as the title suggests; neither within any given chapter nor within the order of chapters.

Philippa Coales, Tim Sharp — 2010-03-18

Mosby's Field Guide to Physical Therapy is a pocket text containing the essential information for physical therapy practice. The aim is to provide a small, comprehensive reference book covering multiple settings and patient populations. The book is directed towards practice in the USA, which occasionally differs from the approach adopted in the UK.

Lynne Gaskell — 2010-01-20

This book is aimed at empowering people with low back pain to manage their pain appropriately. It contains sections on understanding back pain, medical treatments, self treatments and case histories. It encourages self management by different strategies including exercise, relaxation and goal-setting. A section is also included on different types of investigations and treatments available, including medication, injections, surgery, physiotherapy and counselling. Emphasis is placed on the impact of chronic pain on mood and lifestyle, and advice is given on coping strategies, self treatments, pacing and recognition of unhelpful beliefs. Flare-up plans are discussed in terms of managing a higher level of pain, and maintaining movement and activity rather than the pain stopping the sufferer in their tracks.

Anne Binks — 2010-01-15

This book forms part of the ‘Hands on Guide for Therapists’ and is also available as an e-book. The handbook introduces therapists to the practical application of soft tissue release techniques. The book is aimed at therapists with a broad knowledge base and, importantly, carries a strong, unambiguous safety message in the application of techniques.

Raija Kuisma — 2010-01-20

The aim of this book is to bring together the law and practice in community care. It attempts to explain the legal powers and duties of local authorities and the UK National Health Service (NHS), and raise awareness of people's legal rights in community care practice. It covers social care, health and various housing services for vulnerable people, such as older people, younger adults with disabilities or mental health needs, and people with drug and alcohol problems, and also covers issues around informal care. It is aimed at service users, managers and front-line health and social care workers.